- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.00 / $1,882.71 / $5,958.00
| Facility | | $179.00 | $1,882.71 | $5,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.38 / $169.53 / $374.51
| Professional | | $117.38 | $169.53 | $374.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.71 / $89.71
| Professional | | $89.13 | $89.71 | $89.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.95 / $185.52 / $362.98
| Professional | | $181.95 | $185.52 | $362.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.22 / $187.30 / $336.29
| Professional | | $134.22 | $187.30 | $336.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.80 / $227.84 / $302.05
| Professional | | $28.80 | $227.84 | $302.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.16 / $1,593.82 / $3,235.87
| Facility | | $890.16 | $1,593.82 | $3,235.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.55 / $186.00 / $277.74
| Professional | | $137.55 | $186.00 | $277.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.11 / $1,901.00 / $6,105.70
| Facility | | $212.11 | $1,901.00 | $6,105.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.59 / $179.47 / $397.40
| Professional | | $125.59 | $179.47 | $397.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.19 / $197.10 / $272.43
| Professional | | $138.19 | $197.10 | $272.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.76 / $246.76 / $246.76
| Facility | | $246.76 | $246.76 | $246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.34 / $190.28 / $341.25
| Professional | | $136.34 | $190.28 | $341.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.24 / $142.29 / $187.50
| Facility | | $130.24 | $142.29 | $187.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.07 / $173.79 / $201.20
| Professional | | $139.07 | $173.79 | $201.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.07 / $197.23 / $369.58
| Professional | | $156.07 | $197.23 | $369.58 |